Supportive Care

Megace ES and Megace; What does bioequivalence mean? – pro

The advantage is in the concentrated dose that Megace ES offers in contrast to Megace. Megace ES (megestrol acetate) oral suspension is indicated for the treatment of anorexia, cachexia, or an unexplained, significant weight loss in patients with a diagnosis of acquired immunodeficiency syndrome (AIDS). The recommended adult initial dosage of Megace ES (megestrol acetate) oral suspension is 625 mg/day (5 mL/day or one teaspoon daily). The equicaletn

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Zofran – patterns of use – pro

Ondansetron (Zofran) had been FDA approved for two decades and highly effective for nausea and vomiting. It is indicated for: Prevention of nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin ≥ 50 mg/m2. Prevention of nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy. Prevention of nausea and vomiting associated with radiotherapy in patients receiving

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Insomnia in cancer patients – pro

Insomnia of cancer patients can be a manifestation of chemotherapy, antiemetics or steroid drugs,  inadequately treated pain or anxiety and stress, and a workup for insominia is resonable to require.  Cognitive-behavioral therapy appears to be effective for the treatment of insomnia in the general population and also has been upgraded to "likely to be effective" in the Oncology Nursing Society Putting Evidence Into Practice weight of evidence

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Zometa for osteoporosis – pro

Lay Summary: Zoledronic acid is avalable as Zometa and as Reclast for osteoporosis. Each formulation has its indications. Aredia is not FDA indicated for osteoporosis and has no special advantage for this indication over zolendronate. Both pamidronate and zoledronic acid have been shown to reduce bone loss in men undergoing androgen deprivation therapy in prostate cancer. However, zoledronic acid has also been shown to increase bone mineral density

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Marinol for appetite – pro

Marinol is used for appettite support. MARINOL (dronabinol) Capsules is indicated for the treatment of: 1.anorexia associated with weight loss in patients with AIDS; and 2.nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments. Dronabinol (Marinol) has been studied in both HIV and oncology patients, and is particularly useful for patients with both anorexia and

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TPN for malignant bowel obstruction – pro

Management of malignant bowel obstruction is difficult and frought with uncertainties. There is no clear evidence nor consensus on the surgical management of patients with advanced cancer. Surgery can only benefit selected patients with mechanical obstruction and should not be routine practice. Non-surgical treatment includes, bowel decompression, control of nauseas and hydration or intravenous nutrition. With these measures, patients can be maintained

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Prophylactic flucanozole for BMT – pro

Flucanozole prophylaxis for post-transpalnt patients is standrd and supported by a number of guidelines. The duration of prophylaxis is recommended to be from the first day of transplantation and until engraftment, usually around 30 days, or until 7 days after the absolute neutrophil count rises over 1000. This is based on randomized Phase III trials which I also reference, although it is fairly old at this time. Candidal infection is the most common

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Mesna for cyclophosphamide – pro

Cyclophosphamide (CYP) is an alkylating chemotherapeutic agent that is used in a variety of malignant conditions including lymphomas, ovarian and breast cancer. Hemorrhagic cystitis (HC) is a well known and a potentially life-threatening adverse effect of this drug. The incidence of HC is related to the dosage and may be as high as 75% in patients receiving a high intravenous dose. It has been proposed that urothelial damage occurs by direct contact

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Oxycodone – pro

Oxycodone is a full opioid agonist with no antagonist properties whose principal therapeutic action is analgesia. It has an affinity for kappa, mu and delta opiate receptors in the brain and spinal cord. Oxycodone is similar to morphine in its action. Other pharmacological actions of oxycodone are in the CNS (respiratory depression, antitussive, anxiolytic, sedative and miosis), smooth muscle (constipation, reduction in gastric, biliary and pancreatic

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Gastric and duodenal stenting – pro

Patient had an apporpriate and timely workup and management. A CT scan on 4/116 revealed duodenal abstruction. EGD and a dudodenal stent was placed on 4/17. NGT was stopped 4/18 and clear liquids started. I do find a delay in advancing diet; soft diet was started only on the 20th, an unnecessary delay of 1 day. He was discharged on 4/21. In well patients, surgery via gastroenterostomy is the traditional method for palliation of Gastric outlet obstruction

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